June 16, 2020
By Karen O’Connor
Last month the RISE Early Intervention service in Cork, Ireland celebrated its one year anniversary. We asked Dr. Karen O’Connor consultant psychiatrist and National Clinical Lead for the Early Intervention in Psychosis Programme in Ireland to share experiences and key learnings in establishing this pioneering early intervention service.
In 2018, the Health Service Executive in Ireland agreed to fund three Hub and Spoke Early Intervention in Psychosis (EIP) demonstration sites. It was envisaged that learning from the implementation of these demonstration sites would inform and support the future national roll out of an EIP programme in Ireland. Launched in May 2019, The RISE (Responsive Early Intervention for Psychosis Service) in South Lee Mental Health Services, Cork is the first of these three demonstration sites to be established.
The RISE service provides a range of EIP interventions that promote recovery and hope for people experiencing a first episode of psychosis via a Hub and Spoke model of service delivery. This means that some interventions such as keyworker support, psychiatrist appointments, occupational therapy, social work, and vocational support (IPS) are provided at the ‘spoke’ in the community mental health team. Other interventions such as, psychological interventions, physical health and lifestyle interventions, and some family interventions are provided at a central Hub. Clinical responsibility for care remains in the ‘spokes’ (i.e. with the psychiatrist in the community mental health team). Weekly clinical meetings are also held with all RISE staff (Hub and Spoke based staff) and the EIP clinical lead to support fidelity to the EIP model, ensure good team communication and support the delivery of highest quality of EIP care.
Since its launch in May 2019 the RISE service has taken on the care of 45 people presenting with their first episode of psychosis. Of which 85% have engaged in psychological interventions, 72% have engaged with behavioural family therapy, 45% have engaged with an IPS worker, 57% have engaged with a peer support worker and 88% have completed baseline physical health monitoring over the past year. The ARISE programme, a 20-week physical health and lifestyle intervention programme was developed and delivered in collaboration with community dietetics, community sports partnership organisation and a community gym to 11 people with a first episode of psychosis in a local gym. Unfortunately, the Covid-19 pandemic has resulted in the programme ending prematurely but weekly video calls have continued to provide some ongoing support for participants.
Covid-19 has presented additional challenges for this new EIP service. In RISE we have adapted how we are providing our service. We are engaging in an awareness campaign to ensure referrals are not delayed, we are developing a video on team membership and service provision which can be shared online with referrers, service users and their families to reduce barriers to referral and increase engagement. We are delivering all care using a mix of telehealth and face to face (but in a socially distanced way). We are exploring telehealth opportunities to augment delivery of all interventions. However, our experience to date is that considerable face-to-face service is required in EIP. Telehealth is a useful augmentation strategy but not yet an adequate alternative to high quality evidence-based face-to-face care. Particularly for new service users and their families.
Covid-19 also presents a challenge in terms of the roll out of the EIP model of care nationally. However, service transformation and the development of more efficient, more effective ways of working needs to be a priority in the context of Covid-19. It is critical that Early Intervention for Psychosis Services, which have demonstrated their capacity to improve access, quality, health outcomes and save the economy money in the medium and longer term are now rolled out across all of Ireland.
Additional information about EIP in Ireland:
Early Intervention in Psychosis (EIP) is one of the four National Clinical Programmes in Mental Health in Ireland. The Model of Care for this National Clinical Programme was developed in collaboration with the College of Psychiatrists of Ireland and was launched in June 2019. There are two additional EIP demonstration sites due to launch in 2020. One in Sligo and the other in Meath. Prof Catherine Darker from Trinity College Dublin and colleagues are currently completing a process evaluation of the three EIP Demonstration sites, data from which will further inform National roll out of EIP services.
The Early Intervention for Psychosis Model of Care sets out how EIP services in Ireland should be structured and what and how care should be delivered. The Model of Care recommends the development of EIP services across all of Ireland. This care may be delivered in either standalone (> 200,000 urban population) or Hub and Spoke EIP services. These EIP services will improve access, quality, and outcomes by:
- Reducing delays and inequalities by:
- Providing rapid access to expert assessment and collaborative engagement in the community
- Maximising recovery by:
- Providing integrated, individualised, evidence-based treatment including psychological, family (behavioural family therapy), physical health interventions, Individual Placement Support & peer support.
- Addressing co-morbidity early e.g. substance abuse, depression, trauma.
- Preventing relapse by:
- Ensuring assertive follow up (dedicated EIP keyworker and team approach), psycho-education and involve family/ significant others